A nurse is caring for a client with persistent variable decelerations despite intrauterine resuscitation interventions.

An order for an amnioinfusion is received.

The order is for a 250 ml bolus of 0.9% Sodium Chloride over 30 minutes.

Available is 0.9% Sodium Chloride in a 1000ml bag.

How many ml/hr will the nurse program the IV pump for? (Round to the nearest whole number.)

Step 1 is calculate the total volume to be infused: 250 mL

Step 2 is determine the time in hours: 30 minutes ÷ 60 minutes/hour = 0.5 hours.

Step 3 is calculate the rate in mL/hour: 250 mL ÷ 0.5 hours = 500 mL/hour.

The nurse will program the IV pump for 500 mL/hour.

The condition of imminent delivery is correct because the client, gravida 5 para 4 at 39 weeks gestation, is experiencing strong contractions and rectal pressure indicative of advanced labor stages. The physical examination supports active labor, with a firm, palpable uterus, and fetal heart rate present. The urgency of notifying the healthcare provider and encouraging bearing down aligns with labor management in advanced stages. Cervical dilation is essential to assess labor progression, and fetal heart rate monitoring ensures fetal well-being during delivery.

Actions and Parameters Rationale:

1. Notifying the healthcare provider immediately ensures timely medical intervention, crucial for safe delivery and management of any complications.
2. Encouraging the client to bear down with contractions aids the birthing process by utilizing the client’s natural efforts in the expulsion phase of labor.
3. Monitoring cervical dilation provides insight into how far along the client is in labor, helping to anticipate the time of delivery.
4. Continuous monitoring of fetal heart rate ensures the baby's well-being, detecting any distress during labor.

Incorrect Conditions:

1. Preterm labor (A): The client is at 39 weeks gestation, so the labor is not preterm.
2. Placental abruption (B): There are no signs of placental abruption, such as vaginal bleeding, uterine tenderness, or abnormal fetal heart rate patterns.
3. Prolapsed umbilical cord (C): There is no indication of a prolapsed cord, such as sudden fetal distress or visible/palpable cord.